Citation Nr: 0727170
Decision Date: 08/30/07 Archive Date: 09/11/07
DOCKET NO. 05-13 085 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Boston,
Massachusetts
THE ISSUE
Entitlement to service connection for post-traumatic stress
disorder (PTSD).
REPRESENTATION
Appellant represented by: Disabled American Veterans
INTRODUCTION
The veteran served on active duty from May 1969 to December
1971.
This appeal arises from rating decisions of the Department of
Veterans' Affairs (VA) Boston, Massachusetts, Regional
Office(RO) which, in pertinent part, denied service
connection for PTSD.
FINDINGS OF FACT
1. The VA has fully informed the veteran of the evidence
necessary to substantiate his claim and the VA has made
reasonable efforts to develop such evidence.
2. The veteran has a diagnosis of PTSD that is linked to
stressors that did not occur during, or are otherwise related
to his period of active military duty.
CONCLUSION OF LAW
PTSD was not incurred in active service. 38 U.S.C.A. § 1110
(West 2002); 38 C.F.R. § 3.304 (2006).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
The provisions of the Veterans Claims Assistance Act of 2000
(VCAA), codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159,
3.326(a), and as interpreted by the United States Court of
Appeals for Veterans Claims (the Court) have been fulfilled
by information provided to the veteran in letters from the RO
dated in December 2003 and September 2004. Those letters
notified the veteran of VA's responsibilities in obtaining
information to assist the veteran in completing his claim,
identified the veteran's duties in obtaining information and
evidence to substantiate his claim, and requested that the
veteran send in any evidence in his possession that would
support his claim. The December 2003 letter specifically
requested that the veteran provide "specific details of
personal trauma". (See 38 C.F.R. §§ 3.102, 3.156(a), 3.159,
3.326(a)), Quartuccio v. Principi, 16 Vet. App. 183 (2002),
Pelegrini v. Principi, 18 Vet. App. 112 (2004). See also
Mayfield v. Nicholson, 19 Vet. App. 103, 110 (2005), reversed
on other grounds, 444 F.3d 1328 (Fed. Cir. 2006),
Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006);
Mayfield v. Nicholson (Mayfield II), 20 Vet. App. 537 (2006).
The veteran has been made aware of the information and
evidence necessary to substantiate his claim and has been
provided opportunities to submit such evidence. The RO has
properly processed the appeal following the issuance of the
required notice. Moreover, all pertinent development has
been undertaken, examinations have been performed, and all
available evidence has been obtained in this case. The
appellant has not identified any additional evidence that
could be obtained to substantiate the claim. Clearly, from
submissions by and on behalf of the veteran, he is fully
conversant with the legal requirements in this case. Thus,
the content of these letters complied with the requirements
of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). No
further action is necessary for compliance with the VCAA.
During the pendency of this appeal, on March 3, 2006, the
United States Court of Appeals for Veterans Claims (Court)
issued a decision in the consolidated appeal of
Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), which
held that the VCAA notice requirements of 38 U.S.C.A.
§ 5103(a) and 38 C.F.R. § 3.159(b) apply to all elements of a
claim. The Court held that upon receipt of an application
for a claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)
require VA to review the information and the evidence
presented with the claim and to provide the claimant with
notice of what information and evidence not previously
provided, if any, will assist in substantiating or is
necessary to substantiate the elements of the claim as
reasonably contemplated by the application. Where
applicable, the claimant must be notified that a disability
rating and an effective date for the award of benefits will
be assigned if service connection is awarded. Because of the
decision in this case, any deficiency in the initial notice
to the veteran of the duty to notify and duty to assist in
claims involving a disability rating and an effective date
for the award of benefits is harmless error.
Factual Background
The veteran's DD Form 214 noted that the veteran's military
occupational specialty was a medical administration
specialist. He never served outside the United States. The
only medal he was awarded was the National Defense Service
Medal (NDSM).
The veteran's enlistment physical examination report revealed
normal psychiatric findings. In October 1970, he underwent
the necessary medical tests to be assigned to the food
handling unit. Beginning in 1971, service medical records
reveal that the veteran was seen on numerous occasions for
evaluation of alcoholism. In March 1971, it was noted on the
veteran's physical profile that he was not to be assigned
duties that placed him in contact with patients in a
professional capacity. In June 1971, he related a long
family history of alcoholism, and noted that his consumption
had markedly increased since joining the Air Force. He was
not interested in help to overcome his problem, he was only
interested in obtaining a release from service. Psychiatric
examination undertaken in association with his separation
physical examination resulted in the impression of severe
passive-aggressive personality disorder. He was separated
from service as being unsuitable for service.
In an April 1981 statement, a vocational counselor opined
that the veteran turned to alcohol in service when he was
unable to cope with military life.
In a July 1981 statement, R.C.M., M.D. opined that the
veteran turned to alcohol to relieve the tensions and
stresses of military life.
Following a November 1986 evaluation by K.R.A., M.D., the
veteran was diagnosed as having a generalized anxiety
disorder and a dependent personality disorder.
In a May 1992 statement, S.K., MSW, stated that the veteran
suffered from PTSD as a result of severe childhood trauma.
In June 1996, the veteran underwent psychological evaluation
requested by the Massachusetts Rehabilitation Commission.
The veteran described an impoverished childhood, with barely
enough food, an alcoholic father, physical altercations
between his father and mother as well as beatings at the
hands of hi father. Between the ages of eight to twelve, he
was sexually abused by known assailants. He noted that he
was a breach-birth baby with a misshape Ned head; this
resulted in ridicule by his classmates. He reported alcohol
abuse in service, indicating that he attained the rank of E-3
and was a medic. He had a history of one hospitalization for
detoxification in 1980, and had been sober for the past 15
years. Following the evaluation, the diagnosis was chronic
PTSD (with panic disorder). The basis for the diagnosis was
not provided by the examiner.
R.T., M.D. noted in a July 1999 statement that he evaluated
the veteran in October 1998 and found him to be suffering
from PTSD. The physician provided no other information.
Effective April 2002, the veteran was awarded Social Security
Administration disability benefits. The basis of the award
was generalized anxiety.
In a treatment summary from the Harrington memorial Hospital
dated in September 2003, the veteran indicated that he began
drinking at age 16, but that his drinking increased after he
entered the Air Force.
A Massachusetts Rehabilitation Commission Consultative
Examination Report dated in October 2003 was to the effect
that the veteran suffered from PTSD from severe abuse as a
child.
In a statement in support of his claim, received in January
2004, the veteran indicated that as a child, he was sexually
abused by an uncle and a cousin. He acknowledged that his
PTSD resulted from childhood trauma, but insisted that events
in service only aggravated his condition. He referred to his
inability to tolerate military discipline, and his anxiety at
being in the service. He reported that during service, he
drank heavily to "kill the symptoms of PTSD".
A May 2004 statement from the veteran's former squadron
commander was to the effect that he recalled picking the
veteran up from civilian authorities following a drunk
driving charge. He recalled that the veteran had other
problems with alcohol.
In a January 2004 statement, G.B., M.D., a family
practitioner, stated that the veteran had PTSD and was unable
to work. In a June 2004 statement, she indicated that she
had treated the veteran for various disorders, including
depression. The veteran was unable to maintain employment to
a high anxiety state.
Records dated September 1999 to January 2004 from the
veteran's primary health care providers noted treatment for
various disorders, including PTSD, anxiety and depression.
The veteran underwent a VA fee-basis examination in June
2004. The examination was performed by a physician
specializing in neurology. It was indicated that the record
supplied by VA had been reviewed. The examiner remarked that
the veteran had been awarded several medals, including the
National Service Defense Medal, The Vietnam Service Medal
with a Bronze Star, and the Navy Meritorious Commendation
Medal. The veteran related that he joined the Air Force to
avoid being sent to Vietnam, but to his surprise, he was sent
there as a medic, and worked in a dispensary where he
witnessed a great deal of trauma, suffering and death. He
consumed alcohol in order to be able to cope. The physician
noted the veteran's childhood history, and his alcohol
problems during service. The diagnosis was PTSD. The
examiner opined that the veteran had symptoms of PTSD as a
child and adolescent, with exacerbation of his symptoms in
service and continuing thereafter.
A December 2005 statement from an employee at the Harrington
Memorial Hospital Human Services Center was to the effect
that had PTSD after being traumatized as a child. She noted
that the veteran indicated that he was retraumatized during
military service and in his work and school situations.
Law and Regulations
The veteran claims service connection for PTSD. Service
connection may be granted for disability resulting from
disease or injury, incurred in or aggravated by service. 38
U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2006). This
may be accomplished by affirmatively showing inception or
aggravation during service or through the application of
statutory presumptions. 38 C.F.R. § 3.303(a) (2006).
Service connection may be granted for any disease diagnosed
after discharge from active duty when all the evidence,
including that pertinent to service, establishes that the
disease was incurred in service. 38 C.F.R. § 3.303(d) (2006).
Service connection for post- traumatic stress disorder
requires medical evidence diagnosing the condition in
accordance with Sec. 4.125(a) of this chapter; a link,
established by medical evidence, between current symptoms and
an in- service stressor; and credible supporting evidence
that the claimed in- service stressor occurred. Although
service connection may be established based on other in-
service stressors, the following provisions apply for
specified in-service stressors as set forth below:
(1) If the evidence establishes that the veteran engaged in
combat with the enemy and the claimed stressor is related to
that combat, in the absence of clear and convincing evidence
to the contrary, and provided that the claimed stressor is
consistent with the circumstances, conditions, or hardships
of the veteran's service, the veteran's lay testimony alone
may establish the occurrence of the claimed in-service
stressor.
(2) If the evidence establishes that the veteran was a
prisoner-of- war under the provisions of Sec. 3.1(y) of this
part and the claimed stressor is related to that prisoner-of-
war experience, in the absence of clear and convincing
evidence to the contrary, and provided that the claimed
stressor is consistent with the circumstances, conditions, or
hardships of the veteran's service, the veteran's lay
testimony alone may establish the occurrence of the claimed
in-service stressor.
(3) If a post-traumatic stress disorder claim is based on in-
service personal assault, evidence from sources other than
the veteran's service records may corroborate the veteran's
account of the stressor incident. Examples of such evidence
include, but are not limited to: records from law enforcement
authorities, rape crisis centers, mental health counseling
centers, hospitals, or physicians; pregnancy tests or tests
for sexually transmitted diseases; and statements from family
members, roommates, fellow service members, or clergy.
Evidence of behavior changes following the claimed assault is
one type of relevant evidence that may be found in these
sources. Examples of behavior changes that may constitute
credible evidence of the stressor include, but are not
limited to: a request for a transfer to another military duty
assignment; deterioration in work performance; substance
abuse; episodes of depression, panic attacks, or anxiety
without an identifiable cause; or unexplained economic or
social behavior changes. VA will not deny a post-traumatic
stress disorder claim that is based on in-service personal
assault without first advising the claimant that evidence
from sources other than the veteran's service records or
evidence of behavior changes may constitute credible
supporting evidence of the stressor and allowing him or her
the opportunity to furnish this type of evidence or advise VA
of potential sources of such evidence. VA may submit any
evidence that it receives to an appropriate medical or mental
health professional for an opinion as to whether it indicates
that a personal assault occurred. 38 C.F.R. § 3.303(f)
(2006).
If the veteran did not engage in combat with the enemy, his
own testimony by itself is not sufficient to establish the
incurrence of a stressor; rather, there must be service
records or other credible supporting evidence to corroborate
his testimony. Zarycki v. Brown, 6 Vet. App. 91 (1993);
Doran v. Brown, 6 Vet. App. 283 (1994).
Analysis
In the present case, the Board finds that the veteran did not
engage in armed combat during active duty. His DD Form 214
indicated that his military occupational specialty was a
medical administration specialist. His duty stations did not
include any foreign postings. The veteran does not allege
that his claimed psychiatric disability is the result of
combat but is rather associated with stressors associated his
duties while serving as a medical administration specialist
in the United States Air Force. In this regard, there is no
credible evidence that corroborates the veteran's account of
experiencing traumatic events in service that would serve as
a basis for the diagnosis of PTSD. Alternatively, the
veteran contends that his period of military service
aggravated psychiatric problems associated with a childhood
history of being victim of sexual abuse that pre-existed his
entrance into active duty.
In a September 2003 letter, the RO requested that the veteran
provide "specific details of personal trauma" in service,
in order that this trauma could be verified through . To
date, the veteran has not provided specific details which
could be verified through his service records or other
credible supporting evidence to corroborate his statements.
Instead, the veteran has referred to vague, general events
that cannot be verified. As previously stated, service
connection for PTSD based on personal trauma requires
credible supporting evidence, other than the veteran's
statements, that the claimed in- service stressor occurred.
The veteran's service medical records show no onset of a
chronic acquired psychiatric disorder at the time of his
entrance into service, during active duty, or at the time of
his separation from service. The records also do not show
onset of chronic psychotic disorder to a compensable
disabling degree within one year following his separation
from service in December 1971. The veteran was treated for
alcoholism beginning in 1980-1981. The earliest notation of
any psychiatric diagnosis was not until January 1986, over
fifteen years following the veteran's discharge from the Air
Force. To the extent that the veteran now argues that his
military experiences aggravated a pre-existing psychiatric
disorder related to his childhood sexual trauma, the Board
finds that there is no clinical evidence establishing the
actual existence of any such psychiatric disorder at the time
of his entry into service. Although the June 2004 VA fee
basis examination indicated that the veteran's childhood-
based PTSD was exacerbated by service, this opinion was
based on a fabricated history presented by the veteran; to
wit: he never served as a medic in Vietnam, and other than
the NDSM, he never received medals indicative of Vietnam
duty; finally, he was not a medic. His military occupational
specialty was a medical administration specialist, in other
words, a medical clerk charged with typing up reports and
performing other clerical duties. In October 1970, he
underwent physical examination to become a food handler.
While the private medical records indicate that the veteran's
PTSD is a result of an event that occurred during the
veteran's service, this evidence is not based on a documented
injury in service. The Board finds that such reports have
limited probative value as they are merely a recitation of
the veteran's self-reported and unsubstantiated history. See
LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (a bare
transcription of lay history is not transformed into medical
evidence simply because it was transcribed by a medical
professional); Reonal v. Brown, 5 Vet. App. 458, 460-61
(1993) (a medical opinion based on an inaccurate factual
premise has no probative value.) The Board is not required
to accept medical opinions that are based solely on
recitation of history, such as these. Godfrey v. Brown, 8
Vet. App. 113, 121 (1995).
Turning to the private medical records, there appears to be
general agreement that the veteran's PTSD resulted from
childhood sexual trauma. In many reports, the diagnosis of
PTSD was not attributed to any lifetime event. As for the
December 2005 statement that the veteran's childhood-based
PTSD was retraumatized during military service and in his
work and school situations, the examiner did not provide a
basis of the statement. A bare conclusion, even one reached
by a medical professional, is not probative without a factual
predicate in the record. Miller v. Brown, 11 Vet. App. 345,
348 (1998).
The veteran apparently suffered traumatic experiences
associated with his childhood, when he was sexually abused.
While this is a truly tragic and unfortunate life event, it
has no relationship to his later period of military service
and therefore cannot be service-connected. Thus, to the
extent that the veteran seeks VA compensation for PTSD, his
claim in this regard must be denied.
It is accepted that the veteran was diagnosed with a passive-
dependent personality disorder in service. However, for VA
compensation purposes, "In the field of mental disorders,
personality disorders which are characterized by
developmental defects or pathological trends in the
personality structure manifested by a lifelong pattern of
action or behavior, chronic psychoneurosis of long duration
or other psychiatric symptomatology shown to have existed
prior to service with the same manifestations during service,
which were the basis of the service diagnosis will be
accepted as showing preservice origin". 38 C.F.R. § 3.303
(2006)
To the extent that the veteran asserts that there exists a
nexus between his psychiatric disabilities and his period of
military service based on his knowledge of medicine and his
own personal medical history, because there are no
indications in the record that he has received formal medical
training in clinical psychology or psychiatric medicine, he
thus lacks the requisite professional qualifications to make
diagnoses or present commentary and opinion on matters
regarding their etiology and causation. His statements in
this regard are therefore not entitled to be accorded any
probative weight. See Layno v. Brown, 6 Vet. App. 465
(1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992).
The Board has considered all of the pertinent evidence in
this case, but because the evidence is not approximately
balanced with respect to the claim at issue, the benefit-of-
the-doubt doctrine does not apply. The veteran's claim for VA
compensation for PTSD, must therefore be denied. 38 U.S.C.A.
§ 5107(b) (West 2002); 38 C.F.R. § 3.102 (2006); Gilbert v.
Derwinski, 1 Vet. App. 49 (1990).
ORDER
Entitlement to service connection for post-traumatic stress
disorder (PTSD) is denied.
____________________________________________
RENÉE M. PELLETIER
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs